Editor's Desk: A proposal that could hit you like an (I)MAC truck

We can forgive providers if they sense a bit of vertigo coming on. When legislators look to give back power, up truly must seem like down and down seem like up.

Such a forfeit of power could be happening soon, and this has some provider advocates twitching nervously. It happens during discussions of the Medicare Payment Advisory Commission.

Sen. Jay Rockefeller (D-WV) recently introduced a bill that would transfer power of this advisory panel to Congress to the White House. In other words, a shift to the executive branch.

There's also a slightly less aggressive proposal by the White House that's being given a better than 50-50 chance as a compromise solution. As part of its healthcare reform efforts, the administration wants to shift MedPAC's power to something called IMAC (the Independent Medicare Advisory Council).

Under IMAC, five appointed panel members (compared to MedPAC's 17), would determine annual updated payment levels. Then, barring a presidential veto or amendments in the first 30 days, or any revisions requested by Congress in the next 30 days, IMAC's proposed pay rates would go into effect. The deck would clearly be stacked in favor or letting IMAC recommendations stand.

This is bad news for long-term care providers. Twice a year for as long as anyone can remember, MedPAC has recommended freezing nursing home reimbursement levels. And lawmakers, worried about offending voters back at home, have ignored MedPAC's recommendations, granting market-basket increases instead.

But with the creation of IMAC, lawmakers will have somebody to do the dirty work for them. Their hands might not be totally clean, but they could still go home to constituents with big shrugs, explaining that they didn't act because both IMAC and the president had already agreed that it was OK to cut payments.

There will be plenty of ammunition to do just that, too. Even providers admit that Medicare rates have been rather generous. The problem is that Medicare rates need to be artificially high to counterbalance woefully inadequate Medicaid reimbursements.

So the implication is clear: If there's going to be an IMAC, there better be an IMAC 2 (an Independent Medicaid Advisory Council), too. Just like the current Medicare-Medicaid program arrangement, long-term care providers can't afford to have one adjusted without considering the other.

About 60,000 elderly or disabled Medicaid recipients in Louisiana are being told they should expect to lose their benefits in July, and advocates say more than a quarter of them could be forced out of the long-term care facilities they call home.